Early Description of Coronavirus 2019 Disease in Kidney Transplant Recipients in New York
Early Description of Coronavirus 2019 Disease in Kidney Transplant Recipients in New York
复制标题
DOI：
10.1681/asn.2020030375
复制
发表时间：
2020-06-01
影响因子：
13.6
通讯作者：
Mohan, Sumit
中科院分区：
文献类型：
--
作者：
Mohan, Sumit
重要性声明目前，肾移植患者发生COVID-19感染的临床表现、最佳管理策略和结局仍不清楚。我们队列的描述代表了第一个肾移植和COVID-19感染患者队列，包括临床特征、炎症标志物和管理策略，包括减少免疫抑制和使用辅助治疗，包括羟氯喹、阿奇霉素和托珠单抗。这种方法似乎在我们的住院肾移植患者队列中产生了有利的结果，并为这些患者的管理提供了有效的治疗策略。背景新型SARS-CoV-2病毒已导致2019冠状病毒病（COVID-19）全球大流行。虽然免疫抑制个体被认为是在严重疾病的风险增加，很少有人知道他们的临床表现，病程，或outcome.Methods我们报告15肾移植受者从哥伦比亚大学肾移植计划谁需要住院确诊的COVID-19，并描述他们的管理，临床过程，结果患者最常表现为发热（87%）和/或咳嗽（67%）。最初的胸部X线检查最常见的是双侧浸润，但33%没有急性放射学检查结果。患者的管理与免疫抑制剂减少，并添加羟氯喹和阿奇霉素。虽然我们的患者中有27%需要机械通气，但超过一半的患者在随访结束时出院回家。结论患有COVID-19的肾移植受者的表现与普通人群相似。我们目前的治疗方案似乎与良好的结局相关，但需要对更大的患者队列进行更长时间的随访。
Significance Statement Currently, the clinical presentation, optimal management strategy, and outcomes for patients with kidney transplants who develop COVID-19 infection remain unknown. The description of our cohort represents the first cohort of patients with kidney transplants and COVID-19 infection and includes clinical features, markers of inflammation, and a strategy for management that includes both immunosuppression reduction and the use of adjuvant therapy, including hydroxychloroquine, azithromycin, and tocilizumab. This approach appears to have resulted in favorable outcomes in our cohort of hospitalized kidney transplant patients and provides an effective treatment strategy for the management of these patientsBackground The novel SARS-CoV-2 virus has caused a global pandemic of coronavirus disease 2019 (COVID-19). Although immunosuppressed individuals are thought to be at an increased risk of severe disease, little is known about their clinical presentation, disease course, or outcomes.Methods We report 15 kidney transplant recipients from the Columbia University kidney transplant program who required hospitalization for confirmed COVID-19, and describe their management, clinical course, and outcomes.Results Patients presented most often with a fever (87%) and/or cough (67%). Initial chest x-ray most commonly showed bilateral infiltrates, but 33% had no acute radiographic findings. Patients were managed with immunosuppression reduction and the addition of hydroxychloroquine and azithromycin. Although 27% of our patients needed mechanical ventilation, over half were discharged home by the end of follow-up.Conclusions Kidney transplant recipients with COVID-19 have presentations that are similar to that of the general population. Our current treatment protocol appears to be associated with favorable outcomes, but longer follow-up of a larger cohort of patients is needed.